Jim Bryan started working at the university hospital when it was less than a decade old, when patients were housed 16 per room and there were no MRIs, insulin pumps, or even air conditioning.
In 50 years treating patients and training doctors at what is now UNC Health Care, Bryan saw a breathtaking array of new technologies become common practice. Yet the central lesson of his teaching was as old as medicine itself – at times serving as an antidote to his profession’s obsession with progress.
“Care, care, care,” is how Bryan, 82, describes his philosophy. “We are raised in our education to think first of the cure, the biology and pharmacology and all the scientific stuff. But care should be the primary purpose of medicine.”
That focus on patients brought him to embrace the hospice concept back in the 1970s, and he would go on to lead its adoption in North Carolina. Since retiring last year, Bryan has focused much of his time on raising money to build a UNC Health Care hospice center in Chatham County.
He also works as a volunteer physician at a free clinic and a homeless shelter.
Over his years at UNC, he earned a number of awards for his work with patients and student doctors; a medical school award in his name honors residents who excel in patient care.
“He has been a tireless advocate for patients,” says Thad Monroe, a longtime friend and patient. “He is truly a physician in all the best meanings.”
Emphasizing the patient
Bryan was born in Japan, where his father was working as a missionary. The family was forced to return to the United States abruptly in 1941, when the two countries went to war.
They settled in Alabama, where Bryan says his grandfather was a well-known preacher – so well-known that Bryan sought to escape his shadow by becoming a doctor, the profession of his maternal grandfather.
He says his father enrolled him at Davidson College largely because, as a Presbyterian minister, he got a discount.
A professor suggested he train as a physician at the University of Pennsylvania, in part because the medical school at UNC-Chapel Hill was not yet offering four-year degrees.
His specialty was hematology, which led him to work with patients who had lymphoma and leukemia.
At that time, between the Korean and Vietnam wars, he got an exemption from entering the draft for medical students who do national service, and got a job with the federal government’s polio surveillance unit.
For two years, he traveled across the country and beyond, collecting data on outbreaks and administering the vaccines that would eventually eradicate a disease he recalls as a source of fear throughout his youth.
He worked briefly at Emory University before landing at UNC-Chapel Hill in 1964. He went on to earn a master’s in public health, and spent most of his career focused on internal medicine, a more general field that allowed him to instruct young doctors in the basics of patient care.
He watched as chemotherapy and other intense treatments came into mainstream medicine. And he also saw the suffering that went along with them.
“Everyone was desperately trying to find an answer to cancer,” he says. “The sense I got was that they were more interested in the effect of the medicine than the patient.”
It was this line of thought that spawned his interest in the concept of allowing patients to die in their homes, or at least in a more comforting environment than a hospital, an idea that was just beginning to show up in medical journals.
“I needed a way to do better for my folks,” he says.
Bryan traveled to England to visit St. Christopher’s Hospice, a unique facility founded by Cicely Saunders, widely considered the founder of hospice.
The site was designed for people whose lives were ending, so that their medical needs were centered on treating pain. But it was also designed to let them live out the remainder of their lives in comfort.
There were spaces for residents to garden, read, and get their hair done. There was support for their families, and a strong sense of community among the staff and residents.
Bryan was impressed with the sprawling grounds and the thoughtful approach to patient care.
“They thought of everything,” he says.
Bringing hospice home
Back in North Carolina, Bryan started meeting with like-minded community members. Within a few years, a mostly volunteer crew of nurses, social workers and others was starting to care for dying patients in their homes, freeing them of the discomfort and stress of extended hospital stays.
Sometimes just having a quilt on the bed and rugs on the floors brings solace. Patients also have access to counselors and clergy.
“Along with the medical questions, there’s a recognition that you’re going to die, and you may be sad or wounded or depressed,” says Bryan. “If we can make sure that you can mend relationships or see your grandchildren or whatever matters to you, it helps folks feel fulfilled.”
The group set up guidelines for hospice in the state that were in place statewide within five years, he says. Soon after, Medicare started reimbursing for hospice care, which allowed the fledgling operation to move from mostly volunteers to mostly paid nurses and others.
Today, hospice centers that are mostly associated with local hospitals offer home visits to patients by nurses and other staff and volunteers. In addition, several hospice homes serve patients who require too much care to spend their last days at home, but don’t need to be in a hospital.
A hospice home in Hillsborough that was affiliated with Duke University recently moved to the northern part of Durham County, leaving a void for patients in Orange, Chatham and Lee counties.
The new center will be built on land donated by Preston Development, as part of the controversial Chatham Park project that is expected to dramatically increase the population of Pittsboro in the next few decades.
Slated to open early next year, the center will have 10 private rooms, each with its own patio, as well as a kitchen, meditation space and visiting areas, including a children’s play room.
When Bryan retired, he asked his friends and family to donate to the new hospice center instead of giving him gifts – and raised $80,000 in the process.
“It got the whole campaign started,” says Priscilla Bratcher of the Medical Foundation of North Carolina.
He has also supported the project with his time, meeting with potential donors and colleagues in the medical community to promote it. So far, boosters have raised about $1.4 million of the $4.7 million cost of the project. It’s expected to open early next year.
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